The Changing World of European Health Lobbies
01 Jan 2008-
TL;DR: The authors argue that investment by interest groups and policy advocates in EU health lobbying is in response to either the explicit efforts of the Commission to win allies for new policy ventures (so far mostly in public health) or a defensive reaction to the increasingly complex and important EU judicial and legislative agenda in health services, consistent with the findings of Wessels that groups become engaged when they realize the EU is potentially engaged with their issue.
Abstract: Health seems like an unlikely candidate for Europeanization. It is at the core of the welfare state, vitally important to member states and their politicians, and consequently long protected from European Union (EU) policy. EU treaties have only weak and tightly delimited health policy competencies, reflecting member states’ unwillingness to countenance EU (or any outside) intervention in health. The interest group ecology is also tightly bound to states, no matter how international the conference circuit. Even in countries with little or no corporatism, such as the United Kingdom, there is a great deal of ‘private interest government’ in health (Streeck and Schmitter 1985; Salter 2004). In such tightly drawn policy sectors, Europeanization of interests and policymaking might be a dramatic shock for policy-makers, and a dramatic case study of theories of European politics and integration for the scholars. The development of EU health policy is giving scholars just that case study. A fledgling European health policy arena is developing as a result of exogenous shocks to existing systems administered by the Court and Commission. I argue that investment by interest groups and policy advocates in EU health lobbying is in response to either the explicit efforts of the Commission to win allies for new policy ventures (so far mostly in public health) or a defensive reaction to the increasingly complex and important EU judicial and legislative agenda in health services, consistent with the findings of Wessels that groups become engaged when they realize the EU is potentially engaged with their issue (Wessels 2004). Groups that would be interested in liberalization ‐ seemingly just what the EU health services agenda provides ‐ are focusing not on helping the liberalizers at the EU level but on developing connections in member states. The result is NGO and professional dominance that stands in contrast to the usual EU pattern in which business dominates lobbying. It also poses the
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TL;DR: In this article, the authors focus on the four main actors involved and examine how they influence, use, and shape IOs, and find that IO behavior often reflects the interests of politicians, bureaucrats, and interest groups, while the impact of voters is limited.
Abstract: We review the literature on the political economy of international organizations (IOs). Considering IOs as products of the preferences of various actors rather than monolithic entities we focus on national politicians, international bureaucrats, interest groups, and voters. By looking into the details of decision-making in IOs the literature shows that a focus on states as the prime actors in IOs overlooks important facets of the empirical reality. Mainly focusing on empirical research, we structure the paper according to the four main actors involved and examine how they influence, use, and shape IOs. We find that IO behavior often reflects the interests of politicians, bureaucrats, and interest groups, while the impact of voters is limited. The final section discusses proposals for reforms addressing this weak representation of voter preferences. (This abstract was borrowed from another version of this item.)
85 citations
TL;DR: The challenges that created an EU policy arena where none had been are explained; the reasons that decisions taken now will be subject to the logic of path dependency; and the different models that are being put forward for the EU.
Abstract: Health services policy in the European Union is at a critical juncture: a moment at which decisions are highly contingent but, once taken, will shape politics and policy for the future. There is no established EU health services policy community or trajectory because EU health services politics have been a reaction to decisions by the European Court of Justice. Instead, there are a range of different models of health policy, each with different logics, lineages, policy tools and bureaucratic sponsors. The decisions taken in this fluid situation will shape future policy because of the importance and `stickiness' of the EU. Once the European Court of Justice (ECJ) has taken a decision or legislation has been passed, it is difficult to undo. This article explains the challenges that created an EU policy arena where none had been; the reasons that decisions taken now will be subject to the logic of path dependency; and the different models that are being put forward for the EU.
79 citations
Cites background from "The Changing World of European Heal..."
...…in Gastein, it is the DG that runs the European Health Forum, the leading consultative health policy group set up to give the Commission good information, and it is the DG that is trying to find ways to fund EU-level health policy groups in order to create a constituency for itself (Greer, 2008)....
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...The Commission drew back after seeing the hostile reaction, while lobby groups worked to defeat or heavily modify the directive (including health services lobbies, which usually sought simple removal of the health sector) (Greer, 2008)....
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TL;DR: This paper argued that the current attention to obesity is heavily influenced by WHO research reports and that the WHO's recommendations on obesity supply EU institutions with a new agenda, which in turn mobilizes pan-European groups and private sector interests.
Abstract: In this paper, we argue that EU institutions have demonstrated an interest in diet/nutrition for some time, but only in the last five years has obesity risen to the top of the agenda. How did the Commission and European parliament become involved in fighting obesity? It is not because national governments or societal interest groups or public health agencies pushed EU officials to reduce the body mass of European citizens. Rather, drawing on the literature on transnational policy actors, we show that the current attention to obesity is heavily influenced by WHO research reports. Moreover, the WHO's recommendations on obesity supply EU institutions with a new agenda, which in turn mobilizes pan-European groups and private sector interests. Obesity provides a further example of entrepreneurial Commission officials pursuing alliances with international institutions in order to take advantage of their scientific expertise and to carve out a new EU agenda.
38 citations
Cites background from "The Changing World of European Heal..."
...…was ‘political spillover’, in which the activities of supranational institutions propel the EU into a novel policy area, in part by drawing relevant interest groups into a new supranational policy arena, even when there is no societal demand for EU action (Greer, 2009a; Haas, 1958; Niemann, 2006)....
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...…such as cancer (European Cancer League), diabetes (IDFEurope), or Alzheimer’s disease (Alzheimer Europe), which are mostly funded by pharmaceutical companies.4 However, DG Sanco does little to help other public health NGOs overcome their underfunding or their general fragmentation (Greer, 2009a)....
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...Evidence for the claim that member states wanted the EU to intervene in the sphere of public health is very scanty (Greer, 2009b; Steffen et al., 2005)....
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...In a process of ‘political spillover’ (Greer, 2009a; Haas, 1958; Niemann, 2006), Commission officials lost little time in developing new programs; these programs opened up a new arena for public health NGO involvement, despite their having been too weak to press for EU initiatives on their own....
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...These pressures can come from below (referred to as ‘social spillover’ by Greer (2009a)), in that market integration leads to demands for further policy coordination in affiliated areas....
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TL;DR: This article used a newly constructed database to look for inequalities: are the big organizations in Brussels the same as the ones in the EU member states? Are some member states' lobbies more active than others? And does the structure of EU lobbying create insiders and outsiders itself?
Abstract: What effects do interest groups have on the democratization and legitimacy of the European Union (EU)? Interest groups can democratize the EU only to the extent that they do not replicate inequalities. We use a newly constructed database to look for inequalities: Are the big organizations in Brussels the same as the ones in the EU member states? Are some member states' lobbies more active than others? And does the structure of EU lobbying create insiders and outsiders itself? We find representative biases in favor of powerful incumbents, groups from some member states and wellresourced groups.
30 citations
Posted Content•
TL;DR: The conclusion is that a fragile European healthcare union is emerging and a distinct area of EU health law has come into existence, whereas an institutional structure has given a voice to health expertise.
Abstract: Healthcare has only slowly appeared on the European Union’s (EU) policy agenda. EU involvement in policies concerning the organization, financing and the provision of diagnosis, care and cures to ill people developed along three fragmented tracks: (a) EU public health policies concerning the well-being of all people; (b) the application of the free movement principle to national healthcare systems in particular by the EU’s Court of Justice (CJEU); and (c) the austerity packages and the stricter EU surveillance of national budgets since the debt crises. The key questions of this special issue are whether this fragmented EU involvement has now developed into a distinct European healthcare union, and if so what its driving forces have been. Thus, it explores how European integration in healthcare has moved forward despite widespread reluctance. It also examines the underexplored political dynamics and implementation of CJEU case law. The conclusion is that a fragile European healthcare union is emerging. A distinct area of EU health law has come into existence, whereas an institutional structure has given a voice to health expertise. A certain commonality in patients’ rights has also emerged. The EU’s budgetary surveillance deeply intrudes into healthcare policies, but here the involvement of health actors has remained limited. The European Commission and the CJEU have played an important role in the European integration of healthcare policies, but reluctance towards EU intrusion into national healthcare systems left an emphatic mark on CJEU case law, its codification in EU law and its implementation. Variants of the multiple streams approach appeared to be helpful to explain this evolution.
22 citations
Additional excerpts
...Compared with other DGs, SANCO has been characterized as politically weak (Greer 2009; De Ruijter 2016)....
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References
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TL;DR: The advocacy coalition framework (ACF) has generated considerable interest among European policy scholars as mentioned in this paper, and some of the more important findings concerning, and changes to, the ACF since the last major revision in 1993.
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1,209 citations
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458 citations
TL;DR: In this article, the authors focus on interest associations in a disaggregated, rather than global, approach to economics and politics and suggest that the development of private interest governments might be a more viable policy alternative for the future.
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428 citations
TL;DR: The role of interest groups in the policy process has been extensively studied in the British and European literature as mentioned in this paper, focusing on their participation in policy networks of various types, possibly reflecting the original...
Abstract: Much of the British and European literature on the role of interest groups in the policy process focuses on their participation in policy networks of various types. Possibly reflecting the original...
378 citations
TL;DR: The Advocacy Coalition Framework (ACF) was developed to provide a causal theory of the policy process which would serve as one of several alternatives to the familiar stages heuristic, with its recognized limitations as discussed by the authors.
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371 citations